Individual
GAURAV VASHISHTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
27211 LAHSER RD, SUITE # 200, SOUTHFIELD, MI 48034-8469
(248) 358-4892
(248) 358-5125
Mailing address
28411 NORTHWESTERN HWY, SUITE #1050, SOUTHFIELD, MI 48034-5544
(248) 354-4709
(248) 354-4807
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
GV081359
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104934122
—
MI
01
—
110F336360
BCBSM
MI
01
—
1346398971
GROUP NPI
MI
01
—
205485614
TAX ID
MI
01
—
207R00000X
TAXOMOMY
MI
01
—
4301081359
LICENSE
MI
Enumeration date
05/12/2006
Last updated
01/13/2009
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